Abstract

Purpose of review:
With the rapid growth of hip arthroscopy over the past decade, new treatment paradigms as well as recognition of new disease states have sprung forth. The ability to perform complex arthroscopic procedures of the hip such as labral augmentation and reconstruction is essential for hip arthroscopists in the revision setting, with patient selection and indications for various labral treatments the key driver for improved short- and mid-term clinical outcomes.

Recent findings:
Current techniques have been developed to address disease states where the labrum is either unstable, torn, deficient, or otherwise incompetent. Many early reports focused on the description of these techniques with new literature reporting short- and mid-term outcomes. A few of these have demonstrated improved outcomes with a contemporary arthroscopy with emphasis on capsule preservation and repair. Studies have demonstrated that labral repair has improved outcomes over labral debridement, with results of labral reconstruction in a revision approaching those of labral repair. In addition, newer reports have shown significantly improved outcomes and survivorship with capsule repair and therefore should be included in every hip arthroscopy.

Conflict of interest statement

Dustin Woyski declares that he has no conflicts of interest.

Richard Mather is a Board or committee member for Arthroscopy Association of North America and the North Carolina Orthopaedic Association, is a paid consultant for Stryker and KNG Health Consulting, and has received research supports from Zimmer and Reflexion Health.

Figures

Fig. 1

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CT Hip Map of a…

Fig. 1

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CT Hip Map of a right hip with color map overlay demonstrating both…

Fig. 1

CT Hip Map of a right hip with color map overlay demonstrating both pincer and CAM impingement. Acetabular version and femoral torsion also depicted

Decision bubble. Pre-operative and intra-operative decision-making for surgical management of labral pathology can be complex and many times indications overlap and are dependent on surgeon skill and experience. Linear decision algorithms do not capture the interaction of multiple variables and may underestimate the complexity of decision-making. This figure best captures our decision-making approach illustrating treatment of labral pathology as overlapping circles or bubbles; the largest of which is labral repair. This is the recommended treatment for most patients presenting for hip arthroscopy in the primary setting. Rarely would a debridement, augmentation, or reconstruction need to be undertaken in the primary setting. While if a surgeon is willing to take on revision hip arthroscopy, augmentation and reconstruction are tools necessary to treat patients that require restoration of a labral seal and who are at risk for instability without a labrum. The criterion for reconstruction is narrower than augmentation and the indications for reconstruction do not overlap those of repair and should be considered substitutive of repair. Labral debridement in our opinion is reserved for a select group of patients that are low demand, have adequate bony stability, and perhaps have mild degenerative changes and/or would be at risk for not healing/incorporating a labral graft